Update on Program Integrity in Medicaid

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June 2013 | Program Administration

In Chapter 5 of its June 2013 report, the Commission considers program integrity, a key Congressional priority for all publicly funded programs. Program integrity involves a discrete set of activities related to the detection and prevention of fraud, waste, and abuse, but is also an important part of day-to-day program administration activities such as beneficiary and provider enrollment, eligibility, service delivery, and payment.

The chapter highlights two programs, Medicaid Eligibility Quality Control and Payment Error Rate Measurement (commonly known as MEQC and PERM). While both programs review the accuracy of individual Medicaid and CHIP eligibility determinations, the rules for the two programs overlap and do not align well with each other. Chapter 5 lays the groundwork for future efforts to identify duplicative programs and strategies that provide the strongest return on investment. Read more about program integrity in Medicaid.

Publication Type: Reports to Congress

From: June 2013 Report to the Congress on Medicaid and CHIP

Tags: eligibility, eligibility determination, enrollment, federal/state partnership, information technology, program integrity, renewal of eligibility, waste/fraud/abuse